A recent report from the Alzheimer’s Association states that one in nine Americans age 65 or older currently has Alzheimer’s. With the baby boomer generation aging and people living longer, that number is expected to nearly triple by 2050. Alzheimer’s, of course, is just one cause of dementia—mini-strokes (TIAs) are also to blame—so the number of those with dementia may actually be higher.

Caring for someone with dementia is more expensive—and care is often needed longer—than for someone who does not have dementia. Because the cost of care in a facility is out of reach for many families, caregivers are often family members who risk their own financial security and health to care for a loved one.

In this post, we will explore these issues and steps families can take to alleviate some of these burdens.

Cost of Care for the Patient with Dementia—And How to Pay for It

As the disease progresses, so does the level of care the person requires—and so do the costs of that care. Options range from in-home care (starting at $46,332 per year) to adult daycare (starting at $17,676 per year) to assisted living facilities ($43,536 per year) to nursing homes ($82,128 per year for a semi-private room). These are the national average costs in 2016 as provided by Genworth in its most recent study. Costs have risen steadily over the past 13 years since Genworth began tracking them.

Care for a person with dementia can last years, and there are few outside resources to help pay for this kind of care. Health insurance does not cover assisted living or nursing home facilities, or help with activities of daily living (ADL), which include eating, bathing and dressing. Medicare covers some in-home health care and a limited number of days of skilled nursing home care, but not long-term care. Medicaid, which does cover long-term care, was designed for the indigent; the person’s assets must be spent down to almost nothing to qualify. VA benefits for Aid & Attendance will help pay for some care, including assisted living and nursing home facilities, for veterans and their spouses who qualify.

Those who have significant assets can pay as they go. Home equity and retirement savings can also be a source of funds. Long-term care insurance may also be an option, but many people wait until they are not eligible or the cost is prohibitive. However, for the most part, families are not prepared to pay these extraordinary costs, especially if they go on for years. As a result, family members are often required to provide the care for as long as possible.

Financial Costs for the Family

Women routinely serve as caregivers for spouses, parents, in-laws and friends. While some men do serve as caregivers, women spend approximately 50% more time caregiving than men.

The financial impact on women caregivers is substantial. In another Genworth study, Beyond Dollars 2015, more than 60% of the women surveyed reported they pay for care with their own savings and retirement funds. These expenses include household expenses, personal items, transportation services, informal caregivers and long-term care facilities. Almost half report having to reduce their own quality of living in order to pay for the care.

In addition, absences, reduced hours and chronic tardiness can mean a significant reduction in a caregiver’s pay. 77% of those surveyed missed time from work in order to provide care for a loved one, with an average of seven hours missed per week. About one-third of caregivers provide 30 or more hours of care per week, and half of those estimate they lost around one-third of their income. More than half had to work fewer hours, felt their career was negatively affected and had to leave their job as the result of a long-term care situation.

Caregivers who lose income also lose retirement benefits and social security benefits. They may be sacrificing their children’s college funds and their own retirement. Other family members who contribute to the costs of care may also see their standard of living and savings reduced.

Emotional and Physical Costs to Caregivers

In addition to the financial costs, caregivers report increased stress, anxiety and depression. The Genworth study found that while a high percentage of caregivers have some positive feelings about providing care for their loved one, almost half also experienced depression, mood swings and resentment, and admitted the event negatively affected their personal health and well-being. About a third reported an extremely high level of stress and said their relationships with their family and spouse were affected. More than half did not feel qualified to provide physical care and worried about the lack of time for themselves and their families.

Providing care to someone with dementia increases the levels of distress and depression higher than caring for someone without dementia. People with dementia may wander, become aggressive and often no longer recognize family members, even those caring for them. Caregivers can become exhausted physically and emotionally, and the patient may simply become too much for them to handle, especially when the caregiver is an older person providing care for his/her ill spouse. This can lead to feelings of failure and guilt. In addition, these caregivers often have high blood pressure, an increased risk of developing hypertension, spend less time on preventative care and have a higher risk of developing coronary heart disease.

What can be done?

Planning is important. Challenges that caregivers face include finding relief from the emotional stress associated with providing care for a loved one, planning to cover the responsibilities that could jeopardize the caregiver’s job or career, and easing financial pressures that strain a family’s budget. Having options—additional caregivers, alternate sources of funds, respite care for the caregiver—can help relieve many of these stresses. In addition, there are a number of legal options to help families protect hard-earned assets from the rising costs of long term care, and to access funds to help pay for that care.

The best way to have those options when they are needed is to plan ahead, but most people don’t. According to the Genworth survey, the top reasons people fail to plan are they didn’t want to admit care was needed; the timing of the long-term care need was unforeseen or unexpected; they didn’t want to talk about it; they thought they had more time; and they hoped the issue would resolve itself.

Waiting too late to plan for the need for long-term care, especially for dementia, can throw a family into confusion about what Mom or Dad would want, what options are available, what resources can help pay for care and who is best-suited to help provide hands-on care, if needed. Having the courage to discuss the possibility of incapacity and/or dementia before it happens can go a long way toward being prepared should that time come.

Watch for early signs of dementia. The Alzheimer’s Association (www.alz.org) has prepared a list of signs and symptoms that can help individuals and family members recognize the beginnings of dementia. Early diagnosis provides the best opportunities for treatment, support and planning for the future. Some medications can slow the progress of the disease, and new discoveries are being made every year.

Take good care of the caregiver. Caregivers need support and time off to take care of themselves. Arrange for relief from outside caregivers or other family members. All will benefit from joining a caregiver support group to share questions and frustrations, and learn how other caregivers are coping. Caregivers need to determine what they need to maintain their stamina, energy and positive outlook. That may include regular exercise (a yoga class, golf, walk or run), a weekly Bible study, an outing with friends, or time to read or simply watch TV.

If the main caregiver currently works outside the home, they can inquire about resources that might be available. Depending on how long they expect to be caring for the person, they may be able to work on a flex time schedule or from home. Consider whether other family members can provide compensation to the one who will be the main caregiver.

Seek assistance. Find out what resources might be available. A local Elder Law attorney can prepare necessary legal documents, help maximize income, retirement savings and long-time care insurance, and apply for VA or Medicaid benefits. He or she will also be familiar with various living communities in the area and in-home care agencies.

Conclusion

Caring for a loved one with dementia is more demanding and more expensive for a longer time than caring for a loved one without dementia. It requires the entire family to come together to discuss and explore all options so that the burden of providing care is shared by all.

We help families who may need long term care by creating an asset protection plan that will provide peace of mind to all. If we can be of assistance, please don’t hesitate to call.

Can a person apply for Medicaid before assets are spent down to below $2,000?

Once assets are down to $2,000, who is responsible for paying the nursing home costs while waiting for Medicaid approval — the wife, the children – and how much must be paid to the nursing home?

In Florida, an individual can apply for Medicaid benefits to pay nursing home costs before they are actually eligible. The approval will take effect upon the date the application is approved. While the nursing home resident’s application for Medicaid benefits is pending, the nursing home resident is considered “Medicaid pending.” When someone has the status “Medicaid pending,” generally the resident will pay all of the resident’s income to the nursing home facility. If the nursing home resident’s income is greater than what is allowed to qualify for Medicaid benefits, then a qualified income trust wil become necessary.

In some cases, a healthy spouse of the nursing home resident is entitled to a share of the nursing home resident’s income. In other cases, the spouse of the nursing home resident is entitled to a share of the nursing home resident’s assets. In those cases, the nursing home resident can transfer savings to the spouse rather than spending down assets to less than $2,000. As elder law attorneys, we can help you determine how these different scenarios will work in your situation.

For more on Medicaid’s protections for the healthy spouse so that the healthy spouse is not rendered indigent and can remain in the home after the nursing home resident is living in the nursing home (the “community spouse”), click here.

For more on shifting income to the healthy spouse from the spouse in the nursing home, without interfering with receiving the Medicaid benefits to pay the nursing home, click here.

For more on transferring assets to the healthy spouse to bring the nursing home resident’s assets below $2,000, click here.

A new Medicare rule will promote earlier diagnosis of Alzheimer’s disease. Medicare will now reimburse primary care doctors who conduct an Alzheimer’s evaluation and offer information about care planning to elderly patients with cognitive impairment.

According to the Alzheimer’s Association, more than 5 million Americans have the disease. In addition, more than 85 percent of Alzheimer’s patients also have another chronic condition. But many are unaware that they have Alzheimer’s disease because they haven’t been diagnosed.

Under the new rule, primary care doctors who test patients for cognitive impairment can bill Medicare for their services. Testing for Alzheimer’s disease can involve taking a thorough medical history, testing a patient’s mental status, doing a comprehensive physical and neurological exam, and conducting blood tests and brain imaging. Previously, there was no specific Medicare reimbursement for dementia testing, so many doctors did not take the time to do it.

In addition, doctors can bill Medicare if they offer help to Alzheimer’s patients with care planning by providing information on treatments and services. Receiving early diagnosis and proper care planning can be critical for Alzheimer’s patients. According to Robert Egge, Alzheimer’s Association Chief Public Policy Officer, “Proper care planning results in fewer hospitalizations, fewer emergency room visits and better management of medication — all of which improves the quality of life for both patients and caregivers, and helps manage overall care costs.”

While Medicare will now pay for dementia testing and care planning, Medicare does not pay for long-term custodial care services for Alzheimer’s patients. Medicare’s nursing home coverage is limited to skilled care provided by a physical therapist, registered nurse, or licensed practical nurse.

Often families can preserve substantial assets by following legally allowable procedures to protect assets from spend down prior to qualifying for Medicaid, which does provide substantial support for long term care planning and custodial care services. If you have a family member who may need long term care financial support, you should contact to help you determine if long term care planning or Medicaid planning may be beneficial for your family.

Nursing home discrimination against Medicaid residents is illegal.

While it is illegal for a nursing home to discriminate against a Medicaid recipient, it still happens. To prevent such discrimination, nursing home residents and their families need to know their rights and how to fight nursing home discrimination against Medicaid beneficiaries.

The potential for discrimination arises because Medicaid pays nursing homes less than the facilities receive from residents who pay privately with their own funds and less than Medicare pays. Nursing homes are not required to accept any Medicaid patients, but Medicaid payments are a steady guaranteed payment, so many nursing homes agree to accept Medicaid recipients.

When a nursing home agrees to take Medicaid payments, it also agrees not to discriminate against Medicaid residents based on how they are paying. Nursing home discrimination against Medicaid recipients is illegal. Medicaid residents are entitled to the same quality of care as other residents. A nursing home cannot evict residents solely because they qualified for Medicaid.

Unfortunately, nursing home discrimination against Medicaid patients does occur, and the discrimination can take different forms. The nursing home may refuse to accept a Medicaid recipient or may require that a resident pay privately for a certain period of time before applying for Medicaid. When a resident switches from Medicare or private-pay to Medicaid payments, the nursing home may transfer the resident to a less desirable room or claim that it doesn’t have any Medicaid beds, which is illegal.

There is at least one way that nursing homes can treat Medicaid recipients differently, however. Nursing homes are allowed to switch residents who were privately paying for a single room to a shared room once they qualify for Medicaid. In addition, the nursing home is not required to cover personal and comfort care items, such as a telephone or television. In some states families are allowed to pay the difference to get a private room or the care item. Other states do not allow any supplementation.

Joining the states of Florida, Ohio, and Tennessee, the Supreme Court of New Jersey has found that Medicaid planning attorneys should handle Medicaid planning. Non-lawyers who apply the law to a Medicaid applicant’s specific circumstances are engaging in the unauthorized practice of law. Florida’s Supreme Court decision last year, to the same effect, provides that a non-lawyer who engages in Medicaid planning is guilty of the unauthorized practice of law and is committing a criminal felony.

The NJ state Supreme Court received complaints that non-lawyers retained by families or nursing homes to assist with the Medicaid application process were providing erroneous or incomplete law-related advice. A state attorney ethics hotline received reports that non-lawyers charged “clients” large sums of money for what turned out to be faulty Medicaid-planning legal assistance. These actions caused the elderly victims to suffer significant financial losses.

The NJ state Supreme Court was asked for an opinion specifying what activities non-lawyers may engage in and what activities are the unauthorized practice of law. The Committee on the Unauthorized Practice of Law concluded that while non-lawyer Medicaid advisors may provide limited services, “[a]pplying the law to an individual’s specific circumstances generally is the ‘practice of law,’ and should be accomplished through Medicaid planning attorneys. A Medicaid advisor or Application Assistor may provide information on insurance programs and coverage options; help individuals complete the application or renewal; help them with gathering and providing required documentation; assist in counting income and assets; submit the application to the agency; and assist with communication between the agency and the individual. But the advisor may not provide legal advice on strategies to become eligible for Medicaid benefits, including advice on spending down resources, tax implications, guardianships, sale or transfer of assets, creation of trusts or service contracts, and the like,” as those items constitute the practice of law and should be done by Medicaid planning attorneys.

For the Committee on the Unauthorized Practice of Law’s Opinion 53, “Non-Lawyer Medicaid Advisors (Including ‘Application Assistors’) and the Unauthorized Practice of Law,” , click here.

The Medicaid laws are very complex, and deal with a number of overlapping legal doctrines. When you need assistance with Medicaid planning, including the preparation of spend down plans, trusts, personal care contracts, Medicaid asset protection trusts, or other options that comply with the Medicaid laws, you should seek out experienced elder law or Medicaid planning attorneys for that assistance. Otherwise, you and your family may also experience “significant financial losses.”

The answer, as so often is the case in legal matters, is that it depends on your particular situation and circumstances, but in most cases, the prudent answer would be “yes” you do need an elder law attorney to help you accomplish Medicaid planning to preserve your family’s assets and qualify your loved one for Medicaid benefits to pay for nursing home care.

The social worker at your parent’s nursing home assigned to assist you with the preparation of a Medicaid application for your mother knows a lot about the program, but maybe not that one particular rule that applies in your case or the newest changes in the law, which can make all the difference in whether your mother’s application will be approved. In addition, by the time you’re applying for Medicaid, you may have missed out on significant planning opportunities, that could have helped your family preserve valuable assets.

The best option is to immediately consult with a qualified and experienced elder law attorney who can advise you on your family’s entire situation, at the first thought that a nursing home might be necessary. At the very least, the price of the consultation should purchase some peace of mind that things are being accomplished appropriately and in your family’s best interest. What you learn from such a consultation with an experienced elder law attorney can mean significant financial savings or better care for you or your loved one. Proper Medicaid planning may involve the use of trusts, transfers of assets, purchase of annuities or increased income and resource allowances for the healthy parent who is living at home.

The Medicaid laws and regulations collectively create a maze in which the non-lawyer can easily run into dead ends. The experienced elder law attorney is aware of recent changes in the law, the results of the latest “fair hearings” (which are written decisions by administrative judges ruling on appeals of Medicaid denials of benefits made by the Department of Children and Families), and information gathered from other elder law attorneys who involved in dealing with Medicaid matters on a daily basis.

Medicaid Planning Constitutes the Practice of Law and Should Be Undertaken by Elder Law Attorneys

“. . . the testimony revealed that non-lawyer Medicaid planners are essentially unregulated, as there are no licensing, education, or advertising requirements. . . .

Testimony described the type of harm caused by nonlawyer Medicaid planners which includes denial of Medicaid eligibility, exploitation, catastrophic or severe tax liability, and the purchase of inappropriate financial products threatening or destroying clients’ life savings. The potential for public harm is even greater when the nonlawyers put themselves in a position of reliance and advising the customer as to the proper course of action to take. In order to protect the public from harm, it is the opinion of the Standing Committee that the activities described herein constitute the unlicensed practice of law and should not be authorized.”

Consequently, non-lawyers who engage in Medicaid planning are involved in the unlicensed practice of law, which in Florida is a felony.

If you are going to consult with an experienced elder law attorney, the sooner the better. If you wait, it may be too late to take some steps available to preserve substantial assets for the family. Whether your initial consultation is in advance of the actual need for Medicaid benefits to pay for nursing home care, or on a crisis basis because your spouse or elderly parent has just been determined to need Medicaid, we can help. To schedule a consultation, just call us at (904) 448-1969.

The cost of long term care continues to rise, even if slightly for 2016 compared to 2015. The median cost of a private nursing home room in the United States has increased slightly to $92,378 a year, up 1.24 percent from 2015, according to Genworth’s 2016 Cost of Care survey, which the insurer conducts annually. Genworth reports that the median cost of a semi-private room in a nursing home is $82,125, up 2.27 percent from 2015. The rise in prices is modest compared to the 4.2 percent and 3.8 percent gains, respectively, in 2015.

Florida experienced increases in the cost of long term care similar to the national averages:

The price rise was even lower for assisted living facilities, where the median rate ticked up only .78 percent, to $3,628 a month. The national median rate for the services of a home health aide was $20 an hour, the same rate as 2015, and the cost of adult day care, which provides support services in a protective setting during part of the day, actually fell from $69 to $68 a day.

Alaska continues to be the costliest state for nursing home care, with the median annual cost of long term care in a private nursing home room totaling $297,840. Oklahoma again was found to be the most affordable state, with a median annual cost of long term care in a private room of $60,225, which did not increase in 2016.

While prices may not have increased drastically from last year, the survey found that Americans underestimate the cost of in-home long-term care by almost 50 percent. Thirty percent believe it will be less than $417 a month. In fact, an in-home aide working 44 hours a month would cost $3,861, according to Genworth. Proper spend down planning can allow you to qualify for Medicaid benefits to pay the cost of long term care in assisted living facilities and skilled nursing homes.

The 2016 survey was based on responses from more than 15,000 nursing homes, assisted living facilities, adult day health facilities and home care providers. The survey was conducted by phone during January and February of 2016.medicaid planning lawyer elder law attorney to pay for cost of long term care

If your personal assets are not sufficient to cover the costs of long term care, and you do not have long term care insurance, then your only real option to pay for long term care, especially in a skilled nursing home, is to qualify for Medicaid benefits under the Florida Institution Care Program (ICP). We can help you preserve your remaining assets and qualify for Medicaid to pay for your long term care costs. If you, or a loved one, need skilled nursing home care, schedule an appointment with us to determine how we can help you qualify for Medicaid benefits to pay for nursing home care and other cost of long term care, and legally preserve your assets for yourself, your spouse and your family.

Prepare Your Florida QIT Right Here, Right Now

The irrevocable Florida qualified income trust, or "Miller Trust." that you can prepare online, for a fixed fee of $295. The trust document is reviewed by Florida elder law attorney C. Randolph Coleman. Mr. Coleman has been a practicing attorney and member of The Florida Bar for over 30 years.

Mr. Coleman has focused exclusively on elder law in Florida and estate planning matters for the past 30+ years, and has prepared hundreds of qualified income trusts that have been accepted by the Florida Department of Children and Families (or its predecessor HRS) to allow elderly skilled nursing home residents to qualify for Medicaid benefits to pay for the skilled nursing home cost.

The qualified income trust that is prepared online is guaranteed to be accepted by DCAF or you will receive a full refund of your purchase.

Contact Us

Order Your Qualified Income Trust Here

The irrevocable Florida qualified income trust, or "Miller Trust." that you prepare online, for a fixed fee of $295. The trust document is reviewed by Florida elder law attorney C. Randolph Coleman. Mr. Coleman has been a practicing attorney and member of The Florida Bar for over 30 years. If you would like a telephone consultation with Mr. Coleman, or an email consultation with him regarding the qualified income trust, you can purchase those services by clicking here for a telephone consultation, and by clicking here for an email consultation.

Experienced Elder Law Attorney

Mr. Coleman has focused exclusively on elder law in Florida and estate planning matters for the past 30+ years, and has prepared hundreds of qualified income trusts that have been accepted by the Florida Department of Children and Families (or its predecessor HRS) to allow elderly skilled nursing home residents to qualify for Medicaid benefits to pay for the skilled nursing home cost. Mr. Coleman is a member of The Florida Bar Elder Law Section and the Real Property, Probate and Trust Law Section of The Florida Bar. He is rated by his professional peers AV (preeminent) by Martindale-Hubbell and has a 10.0 rating (Superb) by AVVO. He is a member of ElderCounsel, LLC, The National Association of Elder Law Attorneys, The Academy of Florida Elder Law Attorneys, the National Care Planning Council, and WealthCounsel, LLC.

Legal Notice and Disclaimer. The materials within this website are for informational purposes only. This information does not constitute legal advice and should not be relied upon by any individual. Communication of this information is not intended to create, and receipt does not constitute, the establishment of an attorney-client relationship. Internet users and readers should not act upon this information without first seeking professional legal counsel for your particular circumstances. The information on this website is provided only as general information which may or may not reflect the most current legal information.

The hiring of a lawyer is an important decision and should not be based on advertising alone. Before hiring us, please request that we provide you with additional information about our qualifications.